LupusSkin.com
What Is Lupus?
Lupus is a chronic autoimmune disease in which the body’s immune system attacks its tissues and organ. This attack can damage many body parts, including the joints, skin, kidneys, heart, lungs, blood vessels, and brain. It results in inflammation and pain in these body parts and can be fatal in some severe cases.
Once a person develops lupus, they will always have it – with good and bad periods and symptoms ranging from mild or moderate to severe. However, the symptoms can be controlled with medications.
Symptoms of Lupus
Because lupus affects many parts of the body, it can cause a lot of different symptoms.
- Swollen and painful joints
- High fever
- Fatigue
- Body aches
- Rashes
- Skin lesions
- Headaches
- Shortness of breath
- Chest pain
Causes of Lupus
The exact cause of lupus remains unclear, but, indeed, lupus is not contagious. However, genetics can play a potential role in developing lupus because it runs in families. Experts also think it may develop in response to certain hormones, immune system problems, or environmental triggers.
Risk Factors for Developing Lupus
Anyone can develop lupus. But certain people are at higher risk, including:
- Women of ages 15 to 44 – According to the American College of Rheumatology, 10 times more women than men have lupus.
- Certain racial groups – including African American, Asian American, Hispanic/Latino, Native American, or Pacific Islander.
- Family history of lupus or other autoimmune diseases
Prevalence of Lupus
About 300,000 to 1.5 million Americans are living with lupus, and about 24,000 are diagnosed each year.
Types of Lupus
- Systemic lupus erythematosus (SLE)is the most common form of lupus. It commonly causes mouth sores, rash, fatigue, joint pain, swelling, and affects the kidneys.
- Cutaneous lupus is a form of lupus that is limited to the skin.
- Drug-induced lupus is a lupus-like disease caused by certain drugs.
- Neonatal lupus is a rare acquired autoimmune disorder that is present at birth.
Skin Lupus
Skin (cutaneous) lupus is an autoimmune skin disease where the immune system attacks and damages healthy skin cells. This can cause redness, itching, pain, and eventual scarring of the skin. Lupus of the skin can occur by itself or manifest as a part of systemic lupus erythematosus. About 66% of people with lupus will develop skin disease, and 40-70% of people with lupus will have their condition worsened by exposure to UV rays.
Types of Skin Lupus
There are three kinds of cutaneous lupus:
Chronic Cutaneous (Discoid) Lupus appears as disk-shaped, round lesions. The lesions are often red, scaly, and thick. Approximately 10% of people with discoid lupus later develop lupus in other organ systems, but these people probably already had systemic lupus with the skin rash as the first symptom. The lesions usually do not hurt or itch, but they can produce scarring and skin discoloration. Discoid lesions that occur on the scalp may cause the hair to fall out, and if the lesions form scars when they heal, the hair loss may be permanent. Cancer can develop in discoid lesions that have existed for a long time.
Subacute Cutaneous Lupus may appear as red scaly skin areas with distinct edges or red, ring-shaped lesions. The lesions usually occur on the sun-exposed areas – arms, shoulders, neck, and body. The lesions typically do not itch or scar, but they can become discolored. Subacute cutaneous lesions are photosensitive. So, preventive measures should be taken when outdoors or under fluorescent lights.
Acute Cutaneous Lupus occurs when systemic lupus is active. The most typical acute cutaneous lupus is a malar rash – a flattened area of red skin on the face that resembles sunburn. When the rash appears on both cheeks and the nose bridge in a butterfly shape, it is known as the “butterfly rash.” However, the rash can also appear on arms, legs, and body. These lesions tend to be very photosensitive. They typically do not produce scarring, although changes in skin color may occur.
Symptoms of skin lupus
The typical signs of lupus include, but are not limited to, the following:
- Rashes,
- Sores,
- Hair loss, and
- Sensitivity to the sun.
Diagnosis of lupus
Lupus is a difficult disease to diagnose because:
- Many of the symptoms of lupus are non-specific and can also occur in other conditions.
- The signs can vary from person to person.
- The symptoms can overlap with other disorders, which could lead to a misdiagnosis.
- Plus, there is currently no specific test that can diagnose lupus.
A lesion biopsy is inspected for skin lupus under a microscope to see if it has any cutaneous lupus features. If systemic lupus is suspected, a combination of blood tests, urine tests, and physical examination can help the diagnosis.
Treatment of Lupus Rash
The medications used depend on the form of cutaneous lupus. The most common treatments are topical ointments, such as steroid cream or gel. In some cases, liquid steroids are injected directly into the lesions. Oral medications such as an antimalarial are sometimes used.
A new class of drugs, called topical immunomodulators, can treat severe skin conditions. These immunomodulators do not have the side effects associated with corticosteroids. Topical immunomodulators such as tacrolimus ointment and pimecrolimus cream have been shown to suppress the activity of the immune system in the skin.
Thalidomide has also been increasingly accepted as a treatment for skin lupus. It has been shown to significantly improve skin lupus that has not responded to other treatments.
Treatment of Lupus
Treatment of lupus depends on the symptoms and severity. Therapy can help ease inflammation, prevent/relieve flares, and avoid organ damage and other health problems. Some of the available medications include:
Anti-inflammatory Drugs
These can help relieve the fever, joint pain, and swelling that happens with lupus. Nonsteroidal anti-inflammatory drugs (NSAIDs) can usually help with these symptoms. Over-the-counter anti-inflammatory drugs include:
- Aspirin – the first drug approved by the FDA for the treatment of lupus in 1948.
- Ibuprofen
- Naproxen
These drugs can irritate the stomach, so they are best taken with food.
Antimalarial Drugs
In 1955, the FDA approved the antimalarial drug hydroxychloroquine for lupus treatment. Hydroxychloroquine helps to relieve some symptoms such as fatigue, rashes, joint pain, or mouth sores. Antimalarial drugs may also lower the chance of blood clots, which is a concern in some people with lupus. Antimalarial drugs also protect against skin damage from ultraviolet rays. They may protect the body against organ damage linked to lupus.
Corticosteroids
Lupus makes the immune system overactive, so it attacks healthy tissues. Corticosteroids suppress this immune response. These medications are used if lupus causes problems in the heart, lungs, kidneys, brain, or blood vessels. Corticosteroids ease swelling, warmth, and soreness in joints that are caused by inflammation. They can also prevent long-term organ damage.
Corticosteroids can have serious side effects like a higher chance of infections, fragile bones or bone damage, muscle weakness, Diabetes, and Cataracts. They may also cause weight gain, bloating, and mood changes.
Immunosuppressive Drugs
Like corticosteroids, these drugs suppress the immune system to bring symptoms under control and prevent long-term organ damage. These are used if there is no improvement with corticosteroids. Common immunosuppressive drugs for lupus include:
- Some side effects include pancreatitis or a form of hepatitis.
- May lead to bladder problems, hair loss, or fertility problems.
- Can cause nausea, headaches, mouth sores, sun sensitivity, lung infections, and liver damage.
In some cases, immunosuppressive drugs are used with corticosteroids. This way, a lower amount of each medication is used, thereby reducing the side effects. Immunosuppressant drugs can also have severe side effects. For example, they can make it hard for the body to fight infections and increase the risk for some kinds of cancer.
Other Medications
- Anticoagulants thin the blood to prevent clots, a life-threatening lupus symptom. Common side effects of anticoagulants include bloating, diarrhea, upset stomach, vomiting, and appetite loss. Rarely, there may be bruising, a skin rash, a sore throat, back pain, or jaundice.
- Monoclonal Antibodies.Belimumab is the first drug developed just for lupus. It targets specific immune cells and may help reduce the need for steroid treatment. However, it hasn’t been tested thoroughly for the most severe lupus forms. Rituxan is another monoclonal antibody that can sometimes treat lupus when other treatments have failed. Monoclonal antibodies might cause problems like headaches, nausea, hives, or blood pressure changes. These problems usually go away over time.
- Repository Corticotropin Injection.A medicine called H.P. Acthar Gel may help the body make its own steroid hormones like cortisol to fight inflammation. Acthar Gel may cause swelling, changes in blood pressure or glucose tolerance, mood changes, more robust appetite, or weight gain.
Alternative medicine is any treatment that is used instead of traditional medicine. Some people with lupus try to ease symptoms with:
- Acupuncture
- Biofeedback
- Massage
- Meditation
- Chiropractic treatments
- Herbs and other supplements
Studies haven’t shown that these things work in place of medical treatment. In fact, some supplements may make lupus symptoms worse. But some research has found that acupuncture, meditation, and biofeedback can relieve pain and stress when used alongside traditional treatments. It is essential to discuss with a doctor before trying any alternative or complementary therapies for lupus.
Preventive Lifestyle Changes
A healthy lifestyle can help ease the symptoms and prevent flares. It can also help avoid lupus problems, like kidney disease, heart attack, and stroke.
Some helpful tips include:
- Eat a well-balanced diet.
- Quit smoking (or don’t start) to protect the heart and blood vessels.
- Lots of rest to ease stress/fatigue, a common lupus symptom.
- Exercise most days to help sleep, mood, and heart health.
- Always use sunscreen when outdoors.
- Avoid exposure to the sun and artificial ultraviolet light
- Get pneumonia and flu vaccines to protect against infections.
Targeted Therapy for Lupus
One of the challenging aspects of lupus research is that the specific problem with the immune system varies among patients. However, many ongoing clinical trials aim to understand the disease’s genetic underpinnings and develop new and more targeted therapies for treatment.
In recent years, there has been technological development in drug delivery that better targets the specific molecules that may be causing the immune system problem. Older medicines tend to suppress the whole immune system. While this general suppression can ease the symptoms, it is associated with many undesirable side effects.
After thorough clinical trials, the FDA approved the first medication for targeted therapy, Benlysta, in 2011. However, Benlysta is not effective in all patients. There is not enough research to know if it will work in patients with very severe lupus. But it works well for lupus patients with skin and joint involvement.
Advances in the understanding and treatment of lupus over the last several decades have resulted in people with the disease living longer. Despite these advances, there remain many people with lupus who need additional treatment options.
